A patient diagnosed with colon adenocarcinoma, confirmed by biopsy, presents with a suspicious liver lesion and elevated carcinoembryonic antigen (CEA) levels. As a nurse, which intervention is most important to prioritize in the patient's care plan to address her current health status?

B) Coordinate with the oncology team to discuss systemic chemotherapy options.

A) Initiate a blood transfusion to address the mild anemia.

B) Coordinate with the oncology team to discuss systemic chemotherapy options.

C) Educate the patient about dietary changes to manage elevated liver enzymes.

D) Schedule regular monitoring of blood glucose levels due to her diabetes.

A patient with newly diagnosed adenocarcinoma of the colon and evidence of liver metastasis presents with mild anemia and elevated liver enzymes. Considering her current medical condition and history of hypertension and diabetes, what is the most appropriate nursing intervention to prioritize in her care plan?

B) Monitor hemoglobin and hematocrit levels regularly to assess for further anemia progression.

A) Encourage a high-protein diet to improve nutritional status and support liver function.

B) Monitor hemoglobin and hematocrit levels regularly to assess for further anemia progression.

C) Educate the patient on the importance of adhering to her antihypertensive and diabetic medications to prevent exacerbations.

D) Prepare the patient for possible surgical intervention to remove the primary tumor and metastatic lesions.

A patient undergoing chemotherapy for metastatic colon cancer presents with increased fatigue, abdominal pain, and worsening liver function. Which nursing intervention should be prioritized to address the patient's current symptoms and laboratory findings?

B) Implement measures to manage anemia, such as administering a blood transfusion if ordered.

A) Administer prescribed antiemetics to reduce nausea and improve appetite.

B) Implement measures to manage anemia, such as administering a blood transfusion if ordered.

C) Encourage increased fluid intake to prevent dehydration and manage ascites.

D) Monitor vital signs closely and report significant changes to the healthcare provider.

A patient with metastatic colon cancer on chemotherapy reports significant fatigue and new-onset right upper quadrant abdominal pain. Vital signs show tachycardia and slight hypertension, with laboratory tests revealing worsening anemia and deteriorating liver function. Which nursing intervention is the priority to address the patient's current condition?

C) Administer prescribed blood transfusion to manage anemia.

A) Administer prescribed antiemetics to manage potential nausea.

B) Prepare the patient for a paracentesis to relieve ascites.

C) Administer prescribed blood transfusion to manage anemia.

D) Monitor and document the patient's fluid intake and output to assess for dehydration.

A patient with worsening anemia, ascites, and hepatic strain is being managed with diuretics and may require a blood transfusion. During the planning of care, which nursing intervention is most appropriate to prevent complications related to the treatment plan?

B) Monitor serum electrolyte levels and renal function regularly.

A) Encourage the patient to increase fluid intake to prevent dehydration.

B) Monitor serum electrolyte levels and renal function regularly.

C) Administer additional pain medication to manage discomfort.

D) Place the patient on bed rest to conserve energy and reduce fatigue.

During the initial assessment of a patient admitted for closer monitoring and symptom management, the nurse notes the patient's increasing ascites and a slight increase in creatinine levels. Which nursing intervention should take priority to address the patient's current condition?

A) Administer diuretics as prescribed and monitor fluid balance closely.

B) Increase oral fluid intake to prevent dehydration.

C) Encourage ambulation to promote renal perfusion.

D) Prepare the patient for immediate dialysis to manage renal impairment.

A patient undergoing diuretic therapy for ascites has developed hypokalemia and signs of acute kidney injury. What is the most appropriate nursing intervention to prevent further complications?

B) Administer potassium supplements and monitor electrolyte levels closely.

A) Increase the dose of diuretics to manage fluid retention more effectively.

B) Administer potassium supplements and monitor electrolyte levels closely.

C) Restrict fluid intake to manage potential fluid overload.

D) Encourage high protein intake to improve renal function.

A patient with advanced colon cancer and ascites has been started on diuretic therapy but is now showing signs of electrolyte imbalance and worsening renal function. Considering these changes, what is the nurse's priority action?

B) Notify the healthcare provider to re-evaluate the diuretic regimen.

A) Increase the dose of diuretics to enhance fluid reduction.

B) Notify the healthcare provider to re-evaluate the diuretic regimen.

C) Encourage the patient to increase fluid intake to prevent dehydration.

D) Administer antiemetics to manage nausea and vomiting.

A patient with advanced colon cancer and underlying liver involvement has developed hepatic encephalopathy. The healthcare team has initiated treatment with lactulose. What is the primary nursing intervention to monitor the effectiveness of this treatment?

B) Assess the patient's bowel movement frequency and consistency.

A) Monitor the patient's blood glucose levels.

B) Assess the patient's bowel movement frequency and consistency.

C) Check the patient's blood pressure and heart rate regularly.

D) Evaluate the patient's skin for signs of jaundice.

A patient with advanced colon cancer and underlying liver involvement has developed hepatic encephalopathy. What is the primary goal of administering lactulose in this scenario?

B) To decrease ammonia levels by promoting its excretion in the stool

A) To enhance diuretic efficacy and promote fluid excretion

B) To decrease ammonia levels by promoting its excretion in the stool

C) To improve liver function directly by reducing hepatic inflammation

D) To enhance renal clearance of toxins by increasing urine output

colon cancer - Nursing Case Study

Pathophysiology

• Primary mechanism: Genetic mutations in oncogenes (e.g., KRAS) and tumor suppressor genes (e.g., APC) lead to uncontrolled cell proliferation. These mutations disrupt normal cell cycle regulation, promoting the growth of malignant cells in the colon lining.

• Secondary mechanism: Inflammation-driven processes, often linked to conditions like inflammatory bowel disease, can contribute to an environment conducive to cancer development. Chronic inflammation leads to DNA damage and creates a microenvironment that supports tumor growth and survival.

• Key complication: If left untreated, colon cancer can invade surrounding tissues and metastasize to distant organs, such as the liver and lungs, complicating treatment and significantly impacting patient prognosis.

Patient Profile

Demographics:

62-year-old female, retired school teacher

History:

• Key past medical history: Hypertension, Type 2 Diabetes, history of smoking (quit 10 years ago)

• Current medications: Metformin, Lisinopril, Aspirin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Abdominal pain and altered bowel habits

• Key symptoms: Fatigue, weight loss, rectal bleeding, occasional nausea

• Vital signs: Blood pressure 140/90 mmHg, heart rate 102 bpm, respiratory rate 22 breaths per minute, temperature 37.8°C, oxygen saturation 95% on room air

Section 1

New Diagnostic Results:

Following her initial presentation, the patient underwent a colonoscopy, which revealed a sizable mass located in the descending colon. Biopsy results confirmed the presence of adenocarcinoma, consistent with colon cancer. Further staging with a CT scan of the abdomen and pelvis highlighted regional lymphadenopathy and a suspicious lesion in the liver, suggestive of potential metastatic spread. Laboratory findings showed a mild anemia with hemoglobin at 10.8 g/dL and elevated carcinoembryonic antigen (CEA) levels at 15 ng/mL, indicative of tumor activity. Liver function tests were slightly deranged, with an elevated alkaline phosphatase level of 150 U/L and a mildly raised AST level of 55 U/L, raising concerns about hepatic involvement.

These new diagnostic results necessitate a comprehensive evaluation of the extent of the disease and potential treatment options. The presence of a liver lesion significantly impacts the treatment plan, steering the discussion towards systemic chemotherapy and possibly targeted therapies, depending on further molecular profiling. Given her medical history of hypertension and diabetes, careful consideration of her overall health status and potential treatment-related toxicities is crucial. Multi-disciplinary team involvement, including oncology, gastroenterology, and possibly hepatology, will be essential to devise a personalized management plan that addresses both the primary tumor and potential metastatic spread.

The results underscore the need for prompt intervention to prevent further disease progression and complications. The patient's anemia and elevated heart rate may be indicative of ongoing blood loss and systemic effects of the malignancy, necessitating supportive care alongside oncological treatment. Monitoring and managing her cardiovascular status, given her hypertensive background, will be critical. These findings set the stage for discussing treatment goals, potential side effects, and supportive care measures, providing a framework for the patient's ongoing journey with colon cancer.

Section 2

After discussing the diagnostic results with the multidisciplinary team, the patient commenced a systemic chemotherapy regimen, including 5-fluorouracil and leucovorin, with the addition of oxaliplatin to target both the primary tumor and the suspected liver metastasis. A follow-up assessment four weeks into treatment revealed a mixed response. The patient reported significant fatigue and new-onset abdominal pain, particularly in the right upper quadrant, which prompted further evaluation. Vital signs indicated tachycardia with a heart rate of 110 bpm and a slightly elevated blood pressure of 145/90 mmHg. Laboratory tests showed worsening anemia, with hemoglobin dropping to 9.2 g/dL, and liver function tests indicated further deterioration, with AST rising to 75 U/L and alkaline phosphatase increasing to 180 U/L.

Given the new symptoms and laboratory findings, an urgent repeat CT scan of the abdomen was performed. The imaging showed increased size of the liver lesion, suggesting disease progression despite ongoing chemotherapy. Additionally, there was evidence of mild ascites, raising concerns about further hepatic decompensation. In response to these developments, the oncology team considered adjusting the therapeutic approach, possibly incorporating a biologic agent such as bevacizumab to target angiogenesis in an attempt to stabilize the disease. The patient's cardiovascular status required continuous monitoring, particularly in light of her hypertension, to optimize her tolerance to the modified treatment regimen.

The patient's evolving clinical picture highlights the complexity of managing metastatic colon cancer, necessitating continual reassessment and adaptation of the treatment plan. Her increasing abdominal pain and fatigue, coupled with deteriorating liver function, emphasize the need for enhanced supportive care measures, including potential interventions for ascites and optimization of anemia management. These developments will be pivotal in guiding further discussions with the patient about treatment goals and expectations, balancing the quest for disease control with quality of life considerations.

Section 3

As the healthcare team responded to the evolving clinical picture, the patient was admitted for closer monitoring and symptom management. During the initial assessment upon admission, further changes in the patient's condition were noted. The abdominal pain had intensified, becoming more localized in the right upper quadrant, and was now associated with nausea and occasional vomiting. Physical examination revealed a distended abdomen with positive fluid wave, consistent with increasing ascites. Her heart rate remained elevated at 115 bpm, and blood pressure slightly increased to 150/95 mmHg, likely reflecting pain and discomfort. Oxygen saturation was stable at 96% on room air, but she appeared pale and fatigued, suggesting a further decline in her hematologic status.

A repeat set of laboratory investigations confirmed worsening anemia, with hemoglobin decreasing to 8.5 g/dL, necessitating consideration for a blood transfusion to address symptomatic anemia. Liver function tests showed persistent abnormalities, with AST now at 85 U/L and alkaline phosphatase at 200 U/L, indicating ongoing hepatic strain. There was also a mild elevation in bilirubin to 1.8 mg/dL, raising concerns about the liver's synthetic capacity. Additionally, a review of renal function showed a slight increase in creatinine to 1.3 mg/dL, indicating possible renal impairment, which could complicate treatment options.

The multidisciplinary team, including oncology, hepatology, and palliative care specialists, convened to discuss the next steps. The decision was made to initiate diuretic therapy to manage the ascites and provide symptomatic relief, while carefully monitoring renal function. An erythropoiesis-stimulating agent was considered to support anemia management, alongside a potential transfusion. The patient and her family were engaged in discussions about the changes in her treatment plan, emphasizing the need to balance aggressive cancer therapy with supportive measures aimed at improving her comfort and quality of life. These adjustments would set the stage for further evaluations of her response to the modified regimen and any emerging complications.

Section 4

As the healthcare team continued to monitor the patient's response to the interventions, a notable change in her clinical status emerged. Within 48 hours of starting diuretic therapy, the patient experienced a moderate reduction in abdominal distension, providing some relief from the discomfort associated with ascites. However, she began to exhibit signs of electrolyte imbalance, evidenced by a new onset of muscle weakness and cramping. Laboratory results confirmed a significant drop in serum potassium to 3.2 mmol/L, necessitating the initiation of potassium supplementation to prevent further complications. Additionally, her blood pressure decreased to 135/85 mmHg, which, while closer to normal, required careful observation to ensure it did not fall too low, especially in the context of ongoing diuretic use.

Concurrently, the patient's renal function showed further decline, with creatinine rising to 1.5 mg/dL, indicating a progression towards acute kidney injury. This development prompted a re-evaluation of the diuretic regimen, balancing the need for ascites management with the risk of exacerbating renal impairment. To address the anemia, the healthcare team administered a unit of packed red blood cells, resulting in a slight improvement in her hemoglobin level to 9.2 g/dL and a corresponding increase in her energy levels and overall pallor. Despite these interventions, the patient continued to experience intermittent episodes of nausea and vomiting, suggesting incomplete symptom control.

These developments highlighted the complexity of managing her condition, requiring continuous adjustment of therapeutic strategies. The team recognized the need for close integration of supportive care measures, alongside ongoing cancer treatment, to maintain her quality of life. The patient's progress would be closely monitored, particularly her renal function and electrolyte balance, to preempt further complications and guide the next phases of her care. This evolving clinical picture underscored the importance of dynamic, multidisciplinary collaboration in managing the multifaceted challenges presented by her advanced colon cancer.

Section 5

As the healthcare team continued to closely monitor the patient's condition, a new complication emerged, signaling a further evolution in her clinical status. Within the next 24 hours, the patient began to exhibit signs of mental confusion and decreased level of consciousness, raising concerns about potential hepatic encephalopathy, given her underlying liver involvement and ongoing ascites. A neurological assessment revealed that she was disoriented to time and place, responding sluggishly to verbal commands. Her Glasgow Coma Scale (GCS) score dropped to 13, indicating mild impairment. These findings prompted an urgent review of her ammonia levels, which returned significantly elevated at 85 µmol/L, confirming the suspicion of hepatic encephalopathy.

In response to this new development, the healthcare team initiated treatment with lactulose to help reduce ammonia levels and manage her neurological symptoms. Concurrently, the decision was made to adjust her diuretic therapy to a more conservative approach, given the interplay between her renal function and the risk of exacerbating hepatic complications. Her electrolyte levels continued to be monitored meticulously, with particular attention paid to maintaining normokalemia to prevent further muscle weakness and cardiac complications.

This new complication required a reassessment of the patient's overall care plan, emphasizing the need to balance her oncological treatment with the management of her hepatic and renal function. The team arranged for regular neurological evaluations and planned for possible escalation of care, should her mental status not improve with the current interventions. This phase of her journey highlighted the importance of vigilant monitoring and adaptive treatment strategies in managing the intricate challenges posed by advanced colon cancer, underscoring the necessity for seamless communication and collaboration among the multidisciplinary team to optimize patient outcomes.